Healthcare Provider Details

I. General information

NPI: 1760785851
Provider Name (Legal Business Name): KARA DIANE MRNAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 4TH AVE SE
GLENWOOD MN
56334-1820
US

IV. Provider business mailing address

10 4TH AVE SE
GLENWOOD MN
56334-1820
US

V. Phone/Fax

Practice location:
  • Phone: 320-634-4521
  • Fax: 320-634-2244
Mailing address:
  • Phone: 320-634-4521
  • Fax: 320-634-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License Number2005454158
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number2005454158
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number2005454158
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: